2026 ECNP Congress

PS01-1027

The relationship between metacognitive beliefs, emotion recognition, interpersonal emotion regulation, and attachment styles in patients with anxiety disorders

Selma Ertürk Devamlı — Ö. Saraçlı, V. Çakır Kardeş, N. Atasoy, L. Atik · Zonguldak Bülent Ecevit Unıversity, Psychiatry Departmant, Zonguldak, Türkiye

2026 ECNP Congress

Introduction: Generalised anxiety disorder (GAD) is characterised by persistent and excessive worry and is maintained by dysfunctional metacognitive beliefs according to the metacognitive model [1]. Yet the disorder involves interacting cognitive, emotional, and interpersonal processes beyond metacognition alone. Metacognition, emotion recognition, interpersonal emotion regulation, and attachment insecurity have each been linked to anxiety in separate lines of research, but their relative and unique contributions have not been examined simultaneously in a clinical GAD sample. This study tested whether these four processes serve distinct functions by examining predictors of both worry severity and diagnostic group membership within an integrative framework.

Methods: Sixty GAD patients (SCID-5 diagnosed; 68.3% female; mean age 41.31±11.68; mean illness duration 8.34±9.48 years; 83.3% on SSRIs; all clinically stable) and 50 age-, sex-, and education-matched healthy controls completed the MCQ-30, ECR-II, IERQ, RMET, BDI, and PSWQ. Hierarchical regression examined worry predictors: Step 1 entered group and BDI; Step 2 added MCQ-Uncontrollability/Danger and MCQ-Need to Control Thoughts; Step 3 added ECR-Anxiety and ECR-Avoidance. Binary logistic regression examined group membership predictors with all variables entered simultaneously. Bonferroni correction (α=.003, 16 comparisons) was applied and Cohen’s d effect sizes were calculated.

Results: The GAD group scored significantly higher on PSWQ (d=1.37), MCQ-Uncontrollability/Danger (d=0.61), IERQ-Perspective Taking (d=0.70), BDI (d=0.63), and ECR-II total (d=0.66), all surviving Bonferroni correction. No group differences emerged in emotion recognition (RMET; d=0.24). In hierarchical regression, group and BDI explained 35.7% of PSWQ variance. Adding metacognitive variables increased explained variance to 48.8% (ΔR²=.132, p<.001), with MCQ-Need to Control Thoughts as the strongest predictor (β=.265, p=.004); BDI lost significance (p=.354), providing indirect evidence that metacognition mediates the depression–worry link. Adding attachment dimensions yielded no additional variance (ΔR²=.004, p=.664). In logistic regression (Nagelkerke R²=.311; Hosmer-Lemeshow p=.797), IERQ-Perspective Taking was the strongest predictor of GAD membership (OR=1.28, p=.006), followed by BDI (OR=1.07, p=.043). MCQ subscales, attachment dimensions, and RMET were not significant predictors in this model.

Conclusions: Two functionally distinct mechanisms operate in GAD. Metacognitive beliefs, particularly the need to control thoughts, determine worry severity independently of attachment, emotion recognition, and depression, supporting the metacognitive model [1,2]. The non-significant contribution of attachment after controlling for metacognition suggests that the attachment worry link is largely mediated by metacognitive processes rather than representing an independent pathway. Separately, interpersonal perspective taking potentially reflecting social hypervigilance rather than genuine mentalizing discriminates GAD from controls, consistent with findings linking meta-worry to interpersonal problems [3]. The absence of emotion recognition deficits indicates that the core difficulty in GAD lies not in reading social cues but in their metacognitive interpretation. The persistence of elevated metacognitive beliefs despite pharmacological stability underscores the need for non-pharmacological interventions. These converging findings support integrating metacognitive therapy with interventions addressing maladaptive interpersonal strategies in the treatment of GAD

References

  1. Wells, A., 2011. Metacognitive therapy for anxiety and depression. Guilford Press.
  2. Nordahl, H., Vollset, T., Hjemdal, O., 2023. An empirical test of the metacognitive model of generalized anxiety disorder. Scandinavian Journal of Psychology, 64(3), 263–267.
  3. Nordahl, H., Strand, E.R., Hjemdal, O., Nordahl, H.M., 2024. Is meta-worry relevant to interpersonal problems? Cognitive Behaviour Therapy, 53(5), 455–466.